Seán Fleming (Laois, Fianna Fail)
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I thank the Ceann Comhairle for allowing me to raise what is a very important issue in my constituency, namely, the future of services at Midland Regional Hospital Portlaoise. I am disappointed that the Minister for Health, Deputy Harris, is not here this afternoon. Indeed, I raised this matter last autumn and the Minister was not here on that occasion either.

Essentially, the Minister is the source of the problem in respect of Portlaoise. A report has been on the Minister's desk since September 2017 relating to the hospital in Portlaoise. The report includes proposals to close the emergency department and the maternity department and to ensure that all deliveries take place at the Coombe hospital in Dublin. It also proposes closing the paediatric care unit and the intensive care unit as well as ceasing all inpatient surgery. This report was drafted by the HSE and after detailed engagement between the HSE and departmental officials it was presented to the Minister last September, which is seven months ago. At this stage, the future of Portlaoise hospital is out of the hands of the HSE and is in the hands of the Minister for Health, the Cabinet and the Government. Nobody other than the Minister can make a decision on this matter. Therefore, it is up to him to bring the uncertainty regarding the future of the hospital in Portlaoise to an end. This uncertainty is undermining the hospital and causing damage to its future. As I have already mentioned, I raised this matter last November but got no detailed response on that occasion. Since then there was a large rally in Portlaoise in early December. I was pleased that Deputy O'Loughlin from Kildare attended that rally. She is with me in the House today because many people in the Kildare area use the hospital in Portlaoise.

The Laois Oireachtas Members met the Minister in December. He said that he would commence a process of consultation with local GPs and the community and he issued a press statement to that effect before Christmas. I tabled a parliamentary question for written reply on Tuesday last which asked the Minister who is chairing the consultation process that he announced last December, what meetings have taken place since that announcement and the timescale for the conclusion of the consultation process. The Minister's reply was that he had asked for a consultation process to be undertaken and that this is currently "under consideration". It is totally unacceptable that seven months after the Minister received a report, the consultation process on same has not even commenced.

I stated clearly last September that what was needed was a rejection of the report in its entirety and I told the Minister that arrangements should be put in place to improve services at Midland Regional Hospital Portlaoise. The continued delay while this report sits on the Minister's desk is undermining confidence in the hospital and the staff who work there. It is undermining the confidence of patients and people who may want to avail of the hospital's services in the future. It is also undermining the potential recruitment of essential staff at the hospital. Why would anyone take up a senior medical post in the hospital when its future is not clear? There is a report on the Minister's desk which proposes the effective elimination of all services in the hospital. The Minister has allowed that report to sit on his desk for seven months and by doing so, he is deliberately contributing to an undermining of the future of Midland Regional Hospital Portlaoise.

The only thing the Minister needs to do is to get formal Cabinet approval to reject that report in its entirety. He should ask himself why, at a time of such crisis nationwide, officials in the HSE and the Department of Health are spending so much time drawing up reports on the closure of the accident and emergency and maternity departments at Portlaoise hospital. He should have rejected the report when he received it last September, but he did not do so. I am calling on him to reject it now.

Catherine Byrne (Dublin South Central, Fine Gael)
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On behalf of the Minister, Deputy Harris, I thank Deputy Fleming for raising this Topical Issue. I hope the reply that has been provided to me reflects the points that have been made by the Deputy, some of which I have noted on paper. I will read the reply before coming back to the Deputy on any further points he may have. I assure the Deputy that, as the Minister for Health has stated previously, the most important issue in the consideration of services at the Midland Regional Hospital in Portlaoise is the need for patient safety and outcomes to come first. The Minister is committed to securing the further development of the role of Portlaoise hospital, a constituent hospital within the Dublin Midlands hospital group. Since 2014, there has been a focus on supporting the hospital to develop and enhance management capability, implementing changes required to improve clinical service and incorporating the hospital into the governance structures within the Dublin Midlands hospital group. Significant work has been undertaken to strengthen the stability of services at the hospital. Funding has increased by 35% relative to the 2012 budget. Staffing levels have increased by 29% from the 2014 base. Governance and management arrangements in Portlaoise hospital have been strengthened. Additional clinical staff have been appointed. Staff training, hospital culture and communications have improved.

The Dublin Midlands hospital group has been working for some time on a draft plan for a new model of clinical service delivery at Portlaoise hospital which takes account of the need to develop services at the hospital in the context of the development of a model of service provision for the entire hospital group. The draft plan has been submitted to the Department of Health. I emphasise that patient and public requirements are paramount and have underpinned the Department's consideration of the draft plan. The HSE group involved in developing the draft plan for Portlaoise included eight national clinical programmes, the National Ambulance Service and the HSE's national acute hospitals division. HSE consultations took place with the clinical staff and management in Portlaoise hospital, general practitioners, the Irish Prison Service, Tallaght Hospital's surgeons and emergency department services and the Master of the Coombe Hospital. As agreed at a meeting with Members of the Oireachtas from County Laois, no decisions have been taken on the draft action plan. The Minister, Deputy Harris, is giving consideration to a process for wider consultation. I know Deputy Fleming will have other questions to ask. I will reply to some of them when I come in again.

Seán Fleming (Laois, Fianna Fail)
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I thank the Minister of State. I appreciate that she was sent in here to read a script on behalf of the Minister for Health. It is very troubling that four months after the Minister said he was setting up a consultation process, he now seems to have back-tracked. The reply the Minister of State read on his behalf suggests he is merely "giving consideration to a process for wider consultation". The problem is that the HSE and the Minister have caused almost three years of uncertainty. In 2016, the regional management announced the possibility of scaling back the accident and emergency department. From day one, that undermined the future of services at Portlaoise hospital. During 2016 and 2017, the draft report went up and down between the Minister's office, the Department and the HSE before it landed on the Minister's desk in September 2017. The uncertainty must be brought to an end. There is nothing more damaging to a hospital than uncertainty. The Minister, Deputy Harris, is the only person who can eliminate the uncertainty that has put a cloud over the future of Portlaoise hospital for two and a half years now.

It seems that four months after the Minister met us, he is now considering a further process of consultation. We do not want a consultation process at this point in time. We want the Minister and his Cabinet colleagues to take a definitive decision to reject the report that is on the Minister's desk. I do not want to spend another year discussing a report that essentially wants to close most services in the hospital, including the accident and emergency, maternity and paediatric units. We do not want further consultation on that. As the Minister of State has outlined, people were consulted before the report was given to them. The consultation period in relation to the drafting of the report should be over. We want the Minister to decide to reject the report in favour of increases in investment, funding and staffing to ensure the people who rely on Portlaoise hospital enjoy safe and high quality services. This needs to happen as quickly as possible. There should be no further talking. This report needs to be rejected for once and for all so that the cloud of uncertainty that lies over the hospital in Portlaoise can be lifted by the Minister.

Catherine Byrne (Dublin South Central, Fine Gael)
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I assure the Deputy that I was taken aback by one aspect of the script when I was reading it on behalf of the Minister. The Deputy mentioned that the report was received last September. I think there is some justification for some of the issues he has raised. There is nothing as bad as a hospital and its patients being left with uncertainty. I promise the Deputy that I will do my utmost to allay his frustrations and concerns regarding the services at Portlaoise hospital. I hope the Minister for Health will come back to the Deputy as soon as possible. I will emphasise to him that a decision on this matter is needed as soon as possible. Maybe he will correspond with the Deputy on the matter at a personal level. I cannot provide any other information because I do not have it in front of me.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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On a procedural matter, Deputies Fleming and O'Keeffe both suggested that the responsible Minister should attend Topical Issue debates. Everybody appreciates the helpfulness of the Minister of State, Deputy Catherine Byrne, in these matters. I understand that when a Topical Issue is submitted and selected, the office of the responsible Minister communicates with the Deputy who has been selected with a view to reaching an understanding about who will answer the question.

Seán Fleming (Laois, Fianna Fail)
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No.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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That is the procedure that should be followed.

Fiona O'Loughlin (Kildare South, Fianna Fail)
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It has never happened.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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If it is not being followed, the matter will have to be dealt with.

David Cullinane (Waterford, Sinn Fein)
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Hear, hear.